MEDICARE: KEVIN GRIFFIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	3717	TN
2	363A00000X	Physician Assistant	3717	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3717	OTHER	TN	PHYSICIAN ASSISTANT LICENSE

General Provider Information

NPI Number	:	1215412663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GRIFFIN PA-C

Provider Business Mailing Address
First Line	:	638 NASHUA LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-1270
Country	:	US
Telephone Number	:	954-778-7665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 PATTERSON ST STE 205
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2165
Country	:	US
Telephone Number	:	615-329-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	08/18/2021

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Directions to “ KEVIN GRIFFIN PA-C” Practice Location

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